“Following a Clinical Adoption workshop held in November 2009, Canadian change management (CM) practitioners came together to develop a common approach for addressing gaps in e-Health CM practices. Through collaborative dialogue, the group, collectively known as the Pan-Canadian CM Network, conducted a current-state analysis and environmental scan of e-Health CM activities and methodologies. As a result, a National CM Framework was developed to promote a best practice model that supports users in their adoption of e-Health solutions. This article will review the six core framework elements required in a CM process to ensure adoption and achieved return on investment, highlighted by examples of practical Canadian applications.”

The aim of this guide is to encourage users of international comparisons of health and health care data to consider some of the factors that can influence variation between countries, and to assist them in interpreting the results. Drawing on a range of examples—using health and health care data for Organisation for Economic Co-operation and Development (OECD) countries—this guide highlights the types of question to consider about data quality, the basis for country selection and the techniques used to present the results. It is a general guide, and considering each of the factors presented here may not always be possible.

“The FSMB has developed this policy to encourage physicians who use social media and social networking to protect themselves from unintended consequences of such practices and to maintain the public trust by:

• Protecting the privacy and confidentiality of their patients
• Avoiding requests for online medical advice
• Acting with professionalism
• Being forthcoming about their employment, credentials and conflicts of interest
• Being aware that information they post online may be available to anyone, and could be misconstrued

The FSMB acknowledges that there may be instances in which a physician’s professionalism or care is questionable and not addressed in this policy or other FSMB policy. Any time a physician enters into a relationship with a patient, whether it is electronically or in person, the physician should abide by the same rules or statutes established by the state medical board.”

“The challenges of the healthcare industry today require hospitals and health systems to apply all available resources to a strategy toward reducing cost and improving quality. One of healthcare organizations’ greatest resources — and often the key to the success of new initiatives — is their employees. Attracting and retaining skilled employees necessitates a nurturing environment that encourages and rewards innovation through both material and nonmaterial benefits.

While tangible benefits, such as health insurance and compensation, are important to employee satisfaction, what may be more important are intangible benefits, such as respect and recognition. “It’s not about the money,” says Paul Spiegelman, founder and CEO of BerylHealth, a company focused on the patient experience. “People want to feel valued.” In fact, most of the following pillars of success involve abstract concepts that, while difficult to define, may ultimately separate a “good” workplace from a “great” one.”

Objective: Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.

Design: Retrospective cohort study.

Patients and setting: Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008.

Methods: The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33–1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.

Conclusions: Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.

“Background: Finding measures to enhance the dissemination and implementation of their recommendations has become part of most health technology assessment (HTA) bodies’ preoccupations. The Quebec government HTA organization in Canada observed that some of its projects relied on innovative practices in knowledge production and dissemination. A research was commissioned in order to identify what characterized these practices and to establish whether they could be systematized.

Methods: An exploratory case study was conducted during summer and fall 2010 in the HTA agency in order to determine what made the specificity of its context, and to conceptualize an approach to knowledge production and dissemination that was adapted to the mandate and nature of this form of HTA organization. Six projects were selected. For each, the HTA report and complementary documents were analyzed, and semi-structured interviews were carried out. A narrative literature review of the most recent literature reviews of the principal knowledge into practice frameworks (2005-2010) and of articles describing such frameworks (2000-2010) was undertaken.

Results and discussion: Our observations highlighted an inherent difficulty as regards applying the dominant knowledge translation models to HTA and clinical guidance practices. For the latter, the whole process starts with an evaluation question asked in a problematic situation for which an actionable answer is expected. The objective is to produce the evidence necessary to respond to the decision-maker’s request. The practices we have analyzed revealed an approach to knowledge production and dissemination, which was multidimensional, organic, multidirectional, dynamic, and dependent on interactions with stakeholders. Thus, HTA could be considered as a knowledge mobilization process per se.

Conclusions: HTA’s purpose is to solve a problem by mobilizing the types of evidence required and the concerned actors, in order to support political, organizational or clinical decision-making. HTA relies on the mediation between contextual, colloquial and scientific evidence, as well as on interactions with stakeholders for recommendation making. Defining HTA as a knowledge mobilization process might contribute to consider the different orders of knowledge, the social, political and ethical dimensions, and the interactions with stakeholders, among the essential components required to respond to the preoccupations, needs and contexts of all actors concerned with the evaluation question’s issues.”

“In this paper, we discuss the current capacity for governments and their health information and quality agencies to report on the performance of their health systems. We also provide international and Canadian examples of governments that are using improved performance reporting mechanisms to support their health care priorities and goals. To do this, they rely on strategic health plans to guide service implementation, complemented by reporting frameworks that use health indicators to monitor performance over a set period of time, and report their achievements regularly to the public. The strategic plans are revised regularly in light of changing political, economic, and social circumstances within each jurisdiction. In some cases, governments have begun using performance-based funding programs as a way to drive performance improvement and achievement of their health care objectives.

As a country, how can we improve the way we set goals and measure changes to health care and the health of Canadians? How do we make sure that activities are focused on achieving positive results? How do we improve accountability for achieving these results, especially in light of the significant public resources employed in the delivery of health care in Canada? These questions predate the existing health accords and remain to be answered.

This paper is intended to raise the profile of performance reporting in Canada’s health care system and to increase our collective understanding of the opportunities to improve it in the interest of better accountability.”

“This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation.”

“Health data has great value: it helps make the system more accountable, guides best practices for delivering better and safer care and, ultimately, can help improve the health of Canadians. Health data is important to a variety of stakeholders ranging from policy-makers to users of health care systems—the general public. The purpose of this publication is to provide an overview of health care use and resource demands. As questions rise about the sustainability of our health care systems in Canada, it is important to identify what our uses and needs are. By analyzing current health care data, we can ensure resources are being used in the best way possible.”

“Background: Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers’ role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers’ role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers’ influence on innovation implementation in healthcare organizations.

Discussion: Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation.

Summary: Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers’ role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers’ influence to improve the effectiveness of healthcare innovation implementation.”